The priciest outpatient procedure: The colonoscopy

Colonoscopies are one of the most notoriously uncomfortable procedures for U.S. residents aged 50 to 75. It’s not easy fasting for 24 hours, processing strong laxatives, undergoing a sedation process, and then finding a ride home.

Unfortunately, the cost of a colonoscopy doesn’t make the procedure any more pleasant. According to New Choice Health, out-of-pocket costs for a colonoscopy can range between $1,250 to $4,800, which aligns with the average cost of a colonoscopy (CPT code 45380) we see in the Atlas All-Payor Claims dataset.

More and more patients, however, are booking their colonoscopies at local outpatient facilities (or ambulatory surgery centers), rather than their nearest hospital.

Below, we used SurgeryCenterView and the Atlas All-Payor Claims datasets to explore some of the latest trends in colonoscopy procedures in the claim year 2023.

Top 10 colonoscopy procedures in 2023

Fig. 1 Data is sourced from Definitive Healthcare’s SurgeryCenterView and the Atlas All-Payor Claims products. Data accessed August 2024.

What are the most commonly performed colonoscopy procedures?

The most commonly performed colonoscopy procedure found in our database is CPT code 45385. This code is used when a colonoscopy is performed, and a polyp or other abnormal growth is found and removed during the procedure. The snare technique is a common method used for removing these lesions. This procedure accounts for 38.2% of all colonoscopy procedures performed in 2023, according to the most recent 12-month interval in our database.

Following closely behind in second is CPT code 45380, comprising 36.8% of procedures. This code is used when a colonoscopy is performed and a biopsy is taken of the colon tissue, either one or multiple samples.

In third place is CPT code 45378, comprising 21.1% of colonoscopy procedures. This code is used when a colonoscopy is performed for diagnostic purposes and samples are collected using a brush or washing technique, but no biopsy or other procedures are done.

The top three on our list account for most of the colonoscopy procedures performed in 2023. CPT code 45378 is the base code for a diagnostic colonoscopy, covering the most basic procedure. It’s used in a wide range of patients, from screening to those with symptoms. Furthermore, biopsies are often necessary to diagnose conditions like inflammatory bowel disease or to confirm the nature of suspicious lesions. Polyps are common findings during colonoscopies and are especially prevalent as people age. Their removal through polypectomy (CPT code 45385) is an effective measure for preventing colon cancer.

Top 10 ASCs with the most colonoscopy procedures

Fig. 2 Data is sourced from Definitive Healthcare’s SurgeryCenterView and the Atlas All-Payor Claims products. Data accessed August 2024.

Which ASCs had the most colonoscopy claims in 2023?

MidAtlantic Endoscopy 1, located in Lancaster, PA, had the highest percentage of colonoscopy procedures in 2023, at 0.9%.

Tied for second is OneGI – Germantown in Tennessee, and GI Associates & Endoscopy Center in Flowood, MS. Each ASC performed 0.7% of colonoscopy procedures.

And in third place is the Maryland Center for Digestive Health with Anne Arundel Gastroenterology Associates in Annapolis, Maryland, at 0.6%.

Is a colonoscopy considered an outpatient procedure?

Under most circumstances, a colonoscopy can be done as an outpatient procedure, meaning the patient doesn’t need to stay overnight in a hospital or facility. The Mayo Clinic states that colonoscopies typically take about 30 to 60 minutes to complete.

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